American healthcare faces a difficult challenge - improve quality and eliminate disparities while[unreadable] containing costs. Many physicians, policymakers and employers are optimistic that performance incentives[unreadable] - in the form of pay-for-performance and public reporting -- will help improve the quality of American[unreadable] healthcare. Despite the proliferation of these programs, there is little evidence that they produce their[unreadable] intended results, and significant data suggests that they can create negative unintended consequences.[unreadable] In this study proposal, we hypothesize that performance incentives can significantly improve incentivized[unreadable] components of care, but will have a null or negative effect on unincentivized components of care. To[unreadable] examine these questions, we will use a retrospective study design and draw independent samples at three[unreadable] strategically chosen cross-sections in time before and after the introduction of performance incentives at our[unreadable] nation's largest federally-qualified health center, ACCESS Community Health Network. To help account for[unreadable] secular trends that cannot otherwise be addressed in a pre- and post-intervention design, we will compare[unreadable] changes in the care provided to trends in the overall case-mix of patients at ACCESS during the study[unreadable] period.[unreadable] The proposed study will provide a novel contribution to the fields of healthcare quality and equity, as[unreadable] well as to the general literature on incentives. It will develop our methods for empirically evaluating the[unreadable] intended and unintended impact of organizational interventions, provide insight into the effect of penalties in[unreadable] performance incentive programs, yield foundational information on the effect of physician-level incentives.[unreadable] and be the first rigorous empirical evaluation of the use of performance incentives in the Community Health[unreadable] Center setting.[unreadable] The ideal candidate for this line of inquiry must demonstrate aptitude and experience in underserved[unreadable] communities, clinical medicine, and policy-relevant research that draws on interdisciplinary resources.[unreadable] Dr. Chien is that candidate - she has extensive 'hands on' experience working with vulnerable populations.[unreadable] is a practicing general pediatrician, and is a recent alumnus of the Robert Wood Johnson Clinical Scholars[unreadable] program with a track record of research that draws upon the disciplines of medicine, public policy and[unreadable] economics.[unreadable] This career development award is critical for Dr. Chien to further develop the skills and experience[unreadable] necessary to become a nationally respected health services researcher who examines policy-relevant issues[unreadable] related to the use of performance incentives in healthcare, particularly as it pertains to the care delivered to[unreadable] minorities, the medically complex, and the socially disadvantaged.[unreadable]